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Brief Reports   |    
Psychotropic Polypharmacy for the Treatment of Bipolar Disorder in Taiwan
Galen Chin-Lun Hung, M.D., Sc.M.; Shu-Yu Yang, Ph.D.; Yuefan Chen, Sc.M.; Shih-Ku Lin, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201200529
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Dr. Hung, Dr. Yang, and Dr. Lin are with Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan. Dr. Yang is also with the Graduate Institute of Clinical Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung City, Taiwan. Dr. Lin is also with the Department of Psychiatry, Taipei Medical University, Taipei City. Ms. Chen is with the Department of General Pediatrics, Boston Children's Hospital, and was with the Department of Social and Behavioral Science, Harvard School of Public Health, both in Boston, when this report was written. Send correspondence to Dr. Lin (e-mail: daf68@tpech.gov.tw).

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Psychotropic polypharmacy in the treatment of bipolar disorder has proliferated. Yet evidence about the prevalence and predictors of different combinations of polypharmacy in inpatient settings is scarce.

Methods  The Nationwide Psychiatric Inpatient Medical Claims (2000–2007) in Taiwan were used to examine prescriptions for mood stabilizers, antipsychotics, and antidepressants among recently discharged patients with bipolar disorder (N=5,449; 51% women, mean±SD age=36.8±12.4).

Results  A total of 71% of prescriptions involved between-class polypharmacy, and 17% involved within-class polypharmacy. Patients older than 50 and patients at medical centers (>500 beds) were less likely to receive polypharmacy. Lower prescribed doses predicted polypharmacy. Receiving polypharmacy was not associated with a higher rate of readmission within one year.

Conclusions  There was substantial use of various forms of polypharmacy in the treatment of inpatients with bipolar disorder. Randomized studies should be used to compare the cost-effectiveness of common psychotropic combinations and monotherapy to treat bipolar disorder.

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Anchor for Jump
Table 1Predictors of between-class and within-class polypharmacy among recently discharged inpatients with bipolar disorder in Taiwan (N=5,449), 2000–2007
Table Footer Note

a Data for some patients are missing for some predictors. Because there are no reference groups for hospitalization and average daily dose, the comparison indicates the effects on polypharmacy of each increase of one unit.

Table Footer Note

b The average daily dose for the prescription was calculated by adding the daily doses of each medication and dividing by the number of medications prescribed. The daily dose of each medication was calculated by dividing the prescribed daily dose by the defined daily dose, which represents the amount assumed to be the average maintenance daily dose of a medication for an adult. Each unit increase of average daily dose halved the odds of both between-class polypharmacy and within-class polypharmacy.

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References

Drugs@FDA. Silver Spring, Md, US Food and Drug Administration. Accessed July 31, 2012. Available at www.accessdata.fda.gov/scripts/cder/drugsatfda
 
Baldessarini  R;  Henk  H;  Sklar  A  et al:  Psychotropic medications for patients with bipolar disorder in the United States: polytherapy and adherence.  Psychiatric Services 59:1175–1183, 2008
[CrossRef] | [PubMed]
 
Alda  M;  Yatham  LN:  Is monotherapy as good as polypharmacy in long-term treatment of bipolar disorder? Canadian Journal of Psychiatry 54:719–725, 2009
 
Correll  CU;  Frederickson  AM;  Kane  JM  et al:  Equally increased risk for metabolic syndrome in patients with bipolar disorder and schizophrenia treated with second-generation antipsychotics.  Bipolar Disorders 10:788–797, 2008
[CrossRef] | [PubMed]
 
Grunze  H;  Vieta  E;  Goodwin  GM  et al:  The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2009 on the treatment of acute mania.  World Journal of Biological Psychiatry 10:85–116, 2009
[CrossRef] | [PubMed]
 
Yatham  LN;  Kennedy  SH;  Schaffer  A  et al:  Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009.  Bipolar Disorders 11:225–255, 2009
[CrossRef] | [PubMed]
 
Sachs  GS;  Thase  ME;  Otto  MW  et al:  Rationale, design, and methods of the systematic treatment enhancement program for bipolar disorder (STEP-BD).  Biological Psychiatry 53:1028–1042, 2003
[CrossRef] | [PubMed]
 
Moreno  C;  Laje  G;  Blanco  C  et al:  National trends in the outpatient diagnosis and treatment of bipolar disorder in youth.  Archives of General Psychiatry 64:1032–1039, 2007
[CrossRef] | [PubMed]
 
Depp  C;  Ojeda  VD;  Mastin  W  et al:  Trends in use of antipsychotics and mood stabilizers among Medicaid beneficiaries with bipolar disorder, 2001–2004.  Psychiatric Services 59:1169–1174, 2008
[CrossRef] | [PubMed]
 
Mojtabai  R;  Olfson  M:  National trends in psychotropic medication polypharmacy in office-based psychiatry.  Archives of General Psychiatry 67:26–36, 2010
[CrossRef] | [PubMed]
 
Frye  MA;  Ketter  TA;  Leverich  GS  et al:  The increasing use of polypharmacotherapy for refractory mood disorders: 22 years of study.  Journal of Clinical Psychiatry 61:9–15, 2000
[CrossRef] | [PubMed]
 
Biancosino  B;  Barbui  C;  Marmai  L  et al:  Determinants of antipsychotic polypharmacy in psychiatric inpatients: a prospective study.  International Clinical Psychopharmacology 20:305–309, 2005
[CrossRef] | [PubMed]
 
 Guidelines for ATC Classification and DDD Assignment .  Oslo,  Norway,  WHO Collaborating Centre for Drug Statistic Methodology, 2003
 
Dennehy  EB;  Bauer  MS;  Perlis  RH  et al:  Concordance with treatment guidelines for bipolar disorder: data from the systematic treatment enhancement program for bipolar disorder.  Psychopharmacology Bulletin 40:72–84, 2007
[PubMed]
 
Preskorn  SH;  Lacey  RL:  Polypharmacy: when is it rational? Journal of Psychiatric Practice 13:97–105, 2007
[CrossRef] | [PubMed]
 
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